DUNSHAUGHLIN PITCH AND PUTT CLUB
APPLICATION FOR MEMBERSHIP (Adult/Family)
NAME................................................................P&P H’CAP (if any)......................
ADDRESS..........................................................GOLF H’CAP (if any)...................
................................................................AGE (if under 16)..........................
................................................................PHONE NO...................................
What clubs or societies have you been a member of? Golf or P & P.
....................................................................................................................................
Have you been registered with the Pitch and Putt Union of Ireland?
....................................................................................................................................
Give the registration number if known.
If family membership is required please supply the relevant information below. Include
dates of birth of all juveniles between the ages of eight and fifteen inclusive.
Spouse..........................................................................................................................
Children.............................................................................Date of birth......................
...............................................................................Date of birth......................
...............................................................................Date of birth.....................
Annual subscriptions Ladies or Gents €100 Husband and Wife €160 *Family €170
Student €35 Juvenile €25 Senior Citizens €70
*family membership covers husband and wife and juveniles 10 to 15 years inclusive.
Signed_________________________________________________
Private & Confidential
DUNSHAUGHLIN PITCH & PUTT CLUB
Application for Juvenile Membership
Name: ________________________________________________
Address: ________________________________________________
________________________________________________
________________________________________________
Date of Birth: ________________________________________________
Parent/Guardian Name(s): ________________________________________________
Phone Number: ________________________________________________
Phone Number in case of emergency: _________________________________________
GP’s Name: ________________________________________________
Telephone Number: ________________________________________________
Please indicate below if your child suffers from any of the following:
- Respiratory problems:________________________________________________
Allergies:___________________________________________________________Any other medical condition_____________________________________
Allergies:___________________________________________________________Any other medical condition_____________________________________
As a result of this he/she requires the following attention/medication:
__________________________________________________________________
__________________________________________________________________
Parent’s/Guardian’s signature:________________________________________________
Date: __________________________________________
Agreement for Medical Treatment
I hereby consent to _______________________(child’s name) receiving medical treatment if a doctor thinks it is required in an emergency after reasonable attempts to contact me have failed.
Parent’s/Guardian’s signature:__________________________ Date:_________________
Juvenile fee €25 (age 10 –15)